I am a second quarter student in an accelerated BSN program in my second clinical rotation. My clinical is a preceptor-style -- I am paired with an RN, I have one of his/her patients, but am allowed to assist with other patients as my time and the RN allow. I can do pretty much everything on my own except a few skills, anything brand new, or anything I feel I need supervision for, so I am a pretty low-maintanence student. I am always prompt about letting the nurse know what I have done to make sure everything gets covered. Usually this all goes well and I have never had a negative experience until Friday. I'm very frustrated by it and am just trying to get an idea if I acted inappropriately or if it was just a bad day.
The nurse I was paired with was having a bad day. Night shift dropped the ball on several tasks so she and I played catch-up for several hours. Issues arose on my patient, her other two were critical... it was nuts. My patient was relatively easy to care for, and not very time-consuming. She had a few IV push meds, mostly pain killers, about one every hour. I did the assessments, the charting, but there were times when nothing needed done and the patient was resting.
I helped a few of my classmates with their patients since I was caught up, and every once in a while (maybe once every two hours) I would ask my RN if she needed me to help with anything, and she always said no. Finally toward the end of the day I asked her "Is there anything you'd like me to do" and she looked at me and simply said "I could say something right now, but I won't" and went into a patient's room. I was somewhat hurt by this (I can only assume what she wanted to say was something along the lines of "leave me alone"), and I tried to stay out of her way. However, my day on the floor was coming to an end and I never leave without reporting off to my nurse to let her know of any issues with the patient, the patient's status, etc. I feel it would be irresponsible of me not to. But after the comment she made, she avoided me like the plague.
Had the patient been totally fine, I guess I wouldn't have worried as much, but during a chaotic moment my nurse had turned off the pt's TPN infusion, and didn't turn it back on. I assumed she had a reason for turning it off, I didn't realize what a potential problem it could be at the time, so when I mentioned that it was off before I left, she panicked. She asked me to flush the pt's PICC line (there were 2 ports... one was running TPN and the other was running the carrier for the pt's PCA). I tried, but it was occluded. My instructor and I changed the port valve, but it still wouldn't flush. The nurse did tell me to switch the lines (because the TPN was more important) but I was concerned that now my pt was without pain medication (that she had been using regularly). So I needed her to know that the line was still clogged, the TPN was resumed, but the pt now had no pain medication. Every time I opened my mouth she would just say "I can't handle this right now." Finally I told my instructor about the communication problem and SHE told my nurse what I had done and what we tried. Once again I tried to report off and started out with "Well, we're leaving the floor, so--" and she cut me off and said "Thanks for the help" and turned around and walked away.
So I guess I'm trying to figure out if I was the cause of my nurse's avoidance of me, or if she was simply scrambling and was not intending to behave this way. She did commend me twice (and told my instructor) for how I behaved/acted around the doctor who had to come help my patient with an emergent situation and barked orders left and right. I was only asking her if I could help because I was caught up on my work and thought I could be of use. I wasn't asking for anything in particular -- if she wanted me to clean bedpans or get supplies, I would have done so. But I felt like my asking was just an annoyance.
So, back to my title -- was I wrong to offer my assistance to the RN? Should I have simply minded my own patient and, when nothing needed to be done, read the chart or go sit in the breakroom until it was time for the next assessment or med pass?
Usually I'm good about "leaving clinical at clinical" but this has been bothering me all weekend, and I'd like some perspective of what you want (or don't want) a student you're working with to do, so I know how to handle this type of situation in future clinicals.
Jan 28, '07
Don't take it personally, she may have been having a bad shift, and you did what you could to offer, and that is all you could do. she could have delegated something to you but she chose not to, not your problem. You don't know her home situation, she could be overwhelmed with a whole life full of stress, but that is not for you to be bothered with if she does not accept help or offer any explanation. You just can't take it personally, and yes, it would bother me too, but don't go further than that.
Jan 28, '07
Sounds like she had a bad day - I would just leave it at that and not let it bother you or worry you. Some people handle stress in odd and weird ways and she just was tired of dealing with it all right then and there. I don't see anything you did or said that compounded the problem....
She just had a bad day....that's all.
Jan 28, '07
1. Congrats on sticking it through accelerated BSN so far. I knew some during my school days and boy did they have a hard time!
2. I applaud your concern. That it "bothered" you over the weekend is an excellent sign that you are willing to learn and you're also assessing your co-worker/peer's needs/response. I would be concerned if you'd just dismissed it or simply whined about it. You did neither - kudos to you!
3. As the others have pointed out - sometimes, the shift can suck your very life out. Your preceptor was probably just too stressed and busy to empathise and communicate properly. Granted, one can say that being a preceptor she should be better prepared etc. - but life ain't perfect. Often times, preceptors are handed 'regular load' of patients under the pretext that they "have help" from nursing students!
4. Don't let one incident pull you down. Keep plugging away. Perhaps sometime later, one a less busy shift; see if you can pull that nurse aside and express your concerns/feelings. Communication is key and it's very likely that the two of you will come away from that exchange all the more wiser. If I were your preceptor and I did this to you, I'd want you to let me know - face to face, in private if possible.
Jan 28, '07
I learned to use these painful situations as my strength toward being the student's advocate as a nurse (even though I do work nights and infrequently deal with student nurses mind you).
As a student nurse I got ill treatment from some and good treatment from others. Case in point, I was helping the nurse with this soon to deliver patient to the delivery room when she spouts, "We're going to have to straight cath this woman and Hun, she don't want you around!"
Ironically, the next nurse with the same pt, following the epidural asked if I would want to foley catherize the patient. I said yes and the kind nurse even showed me the meatus (wow!). My being a man should not have made any differance with the first nurse, but somehow it did and I was dinged for it.
PS. So keep up the good work :angel2: and let this incident make you stronger not wronger and more helpful with a student nurse in the near future. I have faith you will be a great nurse!
Jan 28, '07
It sounds like you are going to be a very good nurse! Your willingness to help others while making sure your own patients are taken care of is an asset all your future co-workers will appreciate.
Jan 28, '07
For heaven's sake, cut her some slack. She was having a horrendous day. The bottom line is, the patient was her priority. you've had good clinical experiences but now you're detailing an isolated bad day? Why not post about all the good days you've had with good preceptors? Why no details about those days?
This sort of thing frustrates me beyond belief. We (experienced nurses) try to be helpful and teach, but we are people too.
Jan 28, '07
Plus, you assume that her comment was directed at you. I can think of half a dozen reasons she said that, and none of them would have anything to do with you.
Jan 28, '07
i almost always love my student nurses. just love them.
i do find them helpful and usually eager. even if they are just starting out in school, they often have the time to give the patient more tlc than i do.
however, having a student with me takes up more time. i love to teach, and i feel a responsibility to make your clinical day worthwhile. after all, you are paying for the experience, right? just like when precepting a new oreintee, it takes longer to show someone how to do something than it takes to just do it yourself.
so i will say the following things:
1. some people just shouldn't be preceptors. they don't like to teach, don't want to take the time, don't like to be asked questions. these nurses shouldn't be put into that position, but are. some facilities don't give nurses a choice as to wheather they precept or not. and some clinicals are set up where you get assigned a certain patient, and then end up with whichever nurse that patients comes with.
2. some days are very busy, and having a student can compound that. from reading your post, it sounds as though she was irriatated from the night shift to begin with. when i'm in one of those kinds of situations, being asked quesitons makes it worse. even if the question is "how are you?" or "what can i do to help?" having to answer that question takes me away from my train of thought, and can make me forget what i was doing. (i'm easily distracted :d ). however, this is her problem, not yours.
3. there can be personality conflicts between staff nurse/student nurse.
it sounds as though you fit into situation #2, and you handled it appropriatly by going to your instructor for further help when the staff nurse really wasn't available. i'm sure that the clotted picc was the last thing the staff nurse wanted to hear about, and i'm not surprised she didn't take it well. i'd bet it was the message delivered, not the messanger.
Jan 28, '07
I thought of another issue that grrr'd me when I was a student:
My nurse instructor gave me two chest tube patients on TELE and during my shift something awry happened, I think I covered potassium on the wrong patient or charted it on the wrong MAR...
Well, the nurse assigned to these patients was no where to be found...almost a nurse abandonment issue...
I later was called on the med error..and turns out got a lecture from the lecture instructor and the dean of the school.
Should'nt it be the responsibility of the nurse assigned to be in proximity to the patients and not off in a corner chatting with the clinical instructor?!!!
PS.I think my instructor, who had assigned low acuity patients all along then gave me high acuity patients at the end of the clinical assignment should have been held accountable for leading me toward harms way.
Last edit by CaLLaCoDe on Jan 28, '07
Jan 28, '07
Thanks for the encouragement, everyone. I figured it was just a bad day for everybody (when I shared my day at post-conference, everyone else started their story with "Well, my day seems to have gone better than Meghan's did..."), but I wanted to get an idea of whether I was just an oblivious student who was overstepping boundaries or what.
I'll try to put it behind me (I sure have enough stuff to do to keep my mind occupied) and keep plugging away. Hopefully next week will go more smoothly.
Jan 28, '07
Sounds like the day just started pretty badly! When I start a shift like that, and I have students with me, I tell them right out point blank...I need about an hour to figure all this out, then we'll get on with our shift because I have to do all this stuff without being distracted! Most students are like...sure, no problem. Sometimes we just have to work and not talk or be interrupted because that is how things get forgotten or overlooked..hence her TPN. I am sure that just topped her day, no fault of yours!
Personally, I would just let it go. I know when I have had a totally crappy day, I don't want to rehash anything a few days later!
Jan 30, '07
I do not think students are ever in the way. A helping hand is always good to have. Nurses need to always remember their own clinical experiences first. Who was the best nurse you worked with and how did you feel when you were put with a rude nurse. If you know you are not a good preceptor and you can not give a student the best posible experience, then you need to tell the students advisor you would prefer not having students. I have found that nurses that complain about student nurses being in the way are the same nurses that complain about new grads not knowing anything when the become GNs. Its a shame that they could not have made a difference.